Conservative treatment is best option for prostate cancer patients with spinal cord compression

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So Kato, Department of Orthopaedic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan, and others reported at Spineweek that conservative treatment (hormone therapy with external beam radiation therapy) should the first-line treatment for patients with newly diagnosed prostate cancer who have paralytic spinal cord compression

Study presenter and lead author Kato explained that although hormone therapy and external beam radiotherapy have been established as effective treatments for metastatic prostate cancer, their effectiveness for the treatment of spinal cord compression as a result of metastatic prostate cancer has not been established. He added: “The objective of the present study is to clarify the effectiveness of conservative treatment, by hormone therapy and radiation therapy, for the treatment of paralytic spinal cord compression by metastases from newly-diagnosed prostate cancer in patients with no history of previous treatment.”

Kato et al reviewed data for 34 patients who had undergone treatment of newly diagnosed metastatic prostate cancer, diagnosed after presenting with paralysis, with spinal cord compression, between 1975 and 2010 (mean age 71 years old and median time between onset of paralysis and diagnosis 11 days). Twenty-six patients received conservative therapy (hormone therapy with or without external beam radiation therapy) and eight patients received surgery (mostly posterior decompression and fusion with intraoperative radiation therapy). Of those received conservative treatment, the vast majority (22 vs. 4) received both hormone therapy and external beam radiation therapy. Kato said: “We evaluated the neurological status [of patients] using Frankel’s grade before the treatment, immediately after treatment [less than one week after], and one, three, and six months afterwards.”

Prior to treatment, 19 patients in the conservative group (two with Frankel grade B; 17 with Frankel grade C) and all patients in the surgical group were unable to walk. After treatment, of those in the conservative group, 73.6% of patients regained gait within one month, 84.2% regained gait within three months, and only one patient with a pre-treatment status of Frankel grade B–who did not receive external beam radiation therapy–was still unable to walk six months after treatment.

Regarding the four patients in the conservative group who needed more than one month to recover gait, Kato said: “We focused on these cases to identify risk factors for slow recovery, and we found all of these cases hads evere spinal cord compression (>50%) on MRI and their treatment initiation was delayed compared with the 14 cases who needed less time to regain gait (average delay of 21 days vs. average delay of 7.8 days, respectively).” No morbid complications were reported.

Kato et al speculated that the recovery rate was much higher than previous studies because they only included newly diagnosed, in other words, hormone dependent, patients in this study.